Musculosceletal

Emergency
 Open fracture, joints and dislocation
- Open fracture :
• assessment of the patient with an open injury begins with a through history and physical
examination .
Important -information: mechanism of injury, amount of time it has been open, type of potential
contaminants, medical comorbidities, allergies, and history of tetanus administration
Open fracture, joints and dislocation

- Patient with obvious fracture or dislocation

should have a formal attempt at reduction prior to
splinting and obtaining radiographs.

- If the surgery is to be delayed, further irrigation

should be performed in ER
Complete or partial amputation

The essential component of this process is proper

transportation of the amputated part, as an improperly
handled part can drastically alter its viability.

Packaging methods:
- wrapping the part in gauze sponge soaked in normal
saline or RL and placing the bundle of ice
- immersing the part in saline or ringer solution in a
plastic bag and placing the bag on the ice
in case of partial amputation, the soft tissues must again
be handled with great care. A neurovascular examination
should be performed to assess for any viable function.
The exposed soft tissues, should then be covered with
moist gauze dressing soaked in saline or dilute betadine
solution. Then cooled with ice to prevent warm ischemia
 Compartement syndrome

Commonly associated fractures include the tibia, humeral shaft, forearm bones,
andnsupracondylar fractures in children.Other causes of acute compartment
syndrome include crush injury, con-strictive dressings/casts, seizures, intravenous
infiltration, snakebites, infection, prolonged immobilization, burns, acute arterial
occlusion or injury, and exertion.
 Clinical sign
5P : 1. Pain
2. Pulseless
3. paresthesi
4. pale
` 5. paralyse

Penatalaksanaan : Singkirkan penyebab kompresi, O2, Pertahakan

ekstremitas setinggi jantung, konsultasi orthopedi, fasciotomi.
 Compartment syndrome
The decision to perform a fasciotomy is based on a com-
bination of clinical findings, as previously outlined, and
measurement of elevated compartment pressures. If one
suspects a compartment syndrome, frequent reexamination in
the hospital and measurement of compartment pressuresmust
be carried out. Compartment pressures are
most commonlyperformedusing the commerciallydevel-oped
Stryker STIC device
 Aggresive soft tissue infection
Necrotizing fascitis
It’s usually acquired through open
wounds, abrasions, inj sites in iv drug
abusers
Clinical presentation:
- high fever
- Local edema and erythema
- Red, shiny, edematous, ill-sharp
margins
- Tender
- Tx:
- Aggressive debridement and fluid
resucitation
- Antibiotic should be started
immediately: ampicillin/sublactam
Clostridial myonecrosis (gas gangrene)
Characterized by gas production and necrosis
Muscle.
Clinical sign: sudden pain
Wound appearance suddenly change: initially
brown appear then mottled, edematous, and
Covered with multiple bullae with profuse
drainage.
Tx: aggresive debridement=> amputation
- penicilin/clindamycin
 Unstable pelvic fracture
Instabilitas pelvis ditandai dengan melebarnya simfisis pubisatau dislokasi fraktur rami pubis > 2,5
cm.

Penatalaksanaan :
1. Resusitasi cairan
2. Hentikan perdarahan
3. Terapi definitif , pemasangan C.CLAMP
4. Rujuk
 Unstable cervical spine
Penangana pasien fraktur cervical di IGD
1. Ambulasi, seperti 4 orang mengangkat balok
a. 1 orang memegang kepaladengan ekstensi dan traksi leher
b. 1 orang mengangkat punggung
c. 1 orang mengangkat pinggang dan paha
d. 1 orang mengangkat tungkai bawah
2. Diatas bed dengan alas datar dan keras
a. Pasien diposisikan telentang
b. Pasang collar brace
c. Ekstensi leher
3. Infus RL., analgetik dan puasakan npasien
4. Crutchfild, Glison traction 3-5 kg
5. Pindahkan ke bangsal